MEDICARE: JONATHAN JIMENEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD046415	DC

General Provider Information

NPI Number	:	1891182622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN JIMENEZ M.D.

Provider Business Mailing Address
First Line	:	12900 PARK PLAZA DR STE 150
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-9329
Country	:	US
Telephone Number	:	888-291-1358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 MARYLAND AVE NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-7604
Country	:	US
Telephone Number	:	202-396-1780
Fax Number	:	202-388-7568

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	10/22/2018

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